title: High pro-BNP levels predict the occurrence of atrial fibrillation after cryptogenic stroke.
abstract: OBJECTIVE
  Antiplatelets are recommended for secondary prevention in patients with cryptogenic stroke; however, some patients may present with a cardioembolic source that has not been detected, which may modify the treatment. Because high pro-brain natriuretic peptide (BNP) levels are associated with cardioembolic stroke, our objective was to determine whether pro-BNP levels in the acute phase of stroke predict the development of atrial fibrillation (AF) in patients with cryptogenic stroke.
  
  
  METHODS
  A prospective study including patients with cryptogenic stroke was conducted. Demographic data, medical history, and stroke characteristics were assessed at admission. A blood sample was obtained within the first 24 hours from stroke onset to determine pro-BNP levels. Patients were followed by a neurologist at 3 and 6 months and later by a primary care physician for 2 years to evaluate the development of AF.
  
  
  RESULTS
  One thousand fifty patients with ischemic stroke were evaluated. Three hundred seventy-two patients (35%) had cryptogenic stroke. One hundred eight patients were excluded from the study, so 264 patients were valid for the analysis. AF was detected in 15 patients (5.6%) during the follow-up. Patients who developed AF were older, had hypertension more frequently, and showed higher levels of pro-BNP. In the logistic regression model, we found that pro-BNP ≥360 pg/mL was the only variable independently associated with the risk of developing AF (odds ratio 5.70, 95% confidence interval 1.11-29.29, p = 0.037).
  
  
  CONCLUSIONS
  Pro-BNP ≥360 pg/mL increases by 5-fold the possibility of detecting AF during follow-up in patients with cryptogenic stroke.
authors.affiliation: Clinical Neuroscience Research Laboratory, Department of Neurology, Hospital Clínico Universitario, Health Research Institute of Santiago de Compostela-IDIS, University of Santiago de Compostela, Santiago de Compostela, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Rodríguez-Yáñez
authors.forename: Susana
authors.initials: S
authors.lastname: Arias-Rivas
authors.forename: María
authors.initials: M
authors.lastname: Santamaría-Cadavid
authors.forename: Tomás
authors.initials: T
authors.lastname: Sobrino
authors.forename: José
authors.initials: J
authors.lastname: Castillo
authors.forename: Miguel
authors.initials: M
authors.lastname: Blanco
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000096:biosynthesis / Q000097:blood*; D010446:Peptide Fragments / Q000096:biosynthesis / Q000097:blood*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain